Published online May 1, 2006
PEDIATRICS Vol. 117 No. 5 May 2006, pp. 1862 (doi:10.1542/peds.2005-3033)

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Administration of Epinephrine for Life-Threatening Allergic Reactions in School Settings

Kevin R. Murphy, MD
Midwest Allergy and Asthma Clinic
Midwest Children's Chest Physicians
Department of Pediatrics
University of Nebraska Medical Center
Omaha, NE 68130

To the Editor.

The excellent article by McIntyre et al,¹ describing the administration of epinephrine in the Massachusetts school setting, highlights the serious challenge of dealing with life-threatening allergic reactions in school. In Nebraska, we have approached this challenge by working with the Nebraska Board of Education to place both epinephrine and nebulized albuterol in every school building for the treatment of any child with life-threatening anaphylaxis or asthma. Our study reported the outcome in the Omaha public schools, where a protocol was in place to treat any child with life-threatening asthma or anaphylaxis.² Students in the Omaha public schools, like those reported by McIntyre et al for Massachusetts, often had no medication at school. In fact, in our study, one third of the children treated had neither medications nor an asthma action plan at school. Moreover, none of the 5 children who received epinephrine for a severe allergic reaction had epinephrine or an action plan at school.

As with the McIntyre et al study, our work resulted in several important outcomes: increased awareness on the part of parents, teachers, and physicians about the need for an emergency response program; the formation of Attack on Asthma Nebraska (AOAN), which resulted in a state-mandated emergency-response protocol for the administration of life-saving medications in every school; and training for emergency medical personnel in the administration of epinephrine. It is interesting to note that national guidelines were suggested nearly 15 years ago when the National Heart, Lung, and Blood Institute noted that "reliable, prompt access to medications [in schools] is essential."³ The work of McIntyre et al underscores the national scope of life-threatening reactions in school and the importance of the availability of life-saving medications. Even as progress is being made within individual states, in 2001 a national blueprint for policy action for treating childhood asthma called for several school-based goals including the establishment of an asthma surveillance system in our schools.⁴ No child should die of asthma or an allergic reaction in our schools. We have begun to significantly protect the children in Nebraska schools, and McIntyre et al have taken a significant step to do the same in Massachusetts. Ultimately, we need to assure that all state schools have the education, training, and on-site medications for handling life-threatening asthma or anaphylaxis at school.

REFERENCES

1. McIntyre CL, Sheetz AH, Carroll CR, Young MC. Administration of epinephrine for life-threatening allergic reactions in school settings. Pediatrics. 2005;116 :1134 –1140[Abstract/Free Full Text]
2. Murphy KR, Hopp RJ, Kittelson EB, Hansen G, Windle ML, Walburn JN. Life-threatening asthma and anaphylaxis in schools: a treatment model for school-based programs. Ann Allergy Asthma Immunol. 2006; In press
3. Buston T, Fulwood R, Hindi-Alexander M, Hurd S, Taggart V. Guidelines for the Diagnosis and Management of Asthma. Bethesda, MD: National Heart, Lung, and Blood Institute: 1991
4. Lara M, Rosenbaum S, Rachelefsky G, et al. Improving childhood asthma outcomes in the United States: a blueprint for policy action. Pediatrics. 2002;109 :919 –930[Abstract/Free Full Text]

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PEDIATRICS (ISSN 1098-4275). ©2006 by the American Academy of Pediatrics

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Administration of Epinephrine for Life-Threatening Allergic Reactions in School Settings: In Reply

C. Lynne McIntyre and Anne H. Sheetz
Pediatrics 2006 117: 1862. [Extract] [Full Text]  

This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Related articles in Pediatrics Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Murphy, K. R. Search for Related Content PubMed PubMed Citation Articles by Murphy, K. R. Related Collections Allergy & Dermatology Social Bookmarking                         What's this?